Do You Need to Know the Names of Your Doctors While in the Hospital?

Hospitals has always been somewhat unfriendly places and may be growing even more so as pressure mounts to decrease length-of-stay. In many cases, academic medical centers and busy city hospitals have been the prime offenders in this regard. Patients must tolerate balls of residents and medical students trooping through their rooms on rounds. Introductions during such interactions are cursory if they occur at all. The emphasis is on rapid information exchange rather than warm personal interactions. KevinMD has the following comment about patient-doctor relationships (see: Do you know the name of your hospital doctor). Boldface emphasis is mine:

Bob Wachter discusses a recent study concluding that very few could actually name their hospitalist one month after an admission. Ideally, "patients need to have a personal connection to their physicians, particularly at times of great need and uncertainty," writes Dr. Wachter. I agree, but the health system has incentives geared towards giving more disjointed, fractionated care. Hospitalists work in shifts, so it's likely more than one will be caring for a patient during a given admission. If you're in an academic medical center, the cap on resident work-hours increases the number of doctors you'll see, possibly as many as three different teams, in addition to the attending. And of course, there's people like Dr. Ernest Moy, medical officer at the federal Agency for Healthcare Research and Quality, who wonders what the big deal is: "Do you really need to know who your doctor is, or is it more important to know some processes that will help you get at the information you need?" It seems that the depersonalization of medicine is reaching full stride. Doctors are beginning to become no more valuable than faceless technicians

I have discussed the increasing role of hospitalists in previous notes. Although they are a convenient target when discussing the depersonalization of inpatient hospital stays, I think that the problem lies in the far larger issue of our hospital culture. Put another way, it's s more a question of the incentives that we establish and the style of care that results than operational details such as shift duration or assignments. Hospitalists, as the name implies, work for the hospital and its C-level executives. This creates a subtle but critical difference when compared to private physicians. The primary goal of hospitalists is to effectively and efficiently diagnose and treat inpatients and then free up beds for the next patients to be admitted. A warm clinical style is welcome but usually not highly rewarded or even recognized.

This is not to say that progress has not been made in our inpatient care. Hospitals now conduct patient surveys that focus on categories such as the quality of the food and the cleanliness of the rooms. In such surveys, patients are often referred to as guests, although I tend to view this as a cloying affectation. Let's face it -- hospitals have been organized more for the efficiency of the care-givers than the comfort of patients. Luckily and as I pointed out in a note yesterday, fewer and fewer patients are being subjected to hospitalization (see: Outpatient Surgery Now Dominates the Inpatient Variety in the U.S.). Outpatient care may not be that much better than the inpatient variety but you can sure get through it faster and retreat to the comforts of your home.